When should Western blot (WB) or enzyme-linked immunosorbent assay (ELISA) tier testing be repeated after treating Lyme disease?

From the Guidelines

Western blot (WB) or enzyme-linked immunosorbent assay (ELISA) tier testing should not be repeated after treating Lyme disease unless there is objective evidence of reinfection or treatment failure, such as arthritis, meningitis, or neuropathy, as stated in the 2020 guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1. When considering the timing of repeat testing, it's essential to understand that antibody levels take time to decrease after treatment. However, the decision to repeat testing should be based on clinical judgment and the presence of objective signs of disease activity, rather than routine follow-up.

• The 2020 guidelines recommend against additional antibiotic therapy for patients with persistent or recurring nonspecific symptoms, such as fatigue, pain, or cognitive impairment, following recommended treatment for Lyme disease, unless there is evidence of reinfection or treatment failure 1.
• In patients with Lyme arthritis, the decision to repeat testing or treat with additional antibiotics should be based on the severity of joint swelling and the patient's response to initial treatment, rather than routine repeat testing 1.
• It's crucial to note that some patients may continue to have positive antibody tests for months or even years after successful treatment due to persistent antibodies, not active infection, which should be taken into account when interpreting test results 1.
• If symptoms persist despite treatment, additional evaluation may be necessary to determine if there's ongoing infection, incomplete treatment, or development of post-treatment Lyme disease syndrome, rather than simply repeating testing 1.

From the Research

Repeating Western Blot (WB) or Enzyme-Linked Immunosorbent Assay (ELISA) Tier Testing

• There is no specific guidance on when to repeat WB or ELISA tier testing after treating Lyme disease, as the provided studies do not directly address this question 2, 3, 4, 5, 6.
• The studies focus on the diagnosis, treatment, and persistence of Lyme disease, as well as the challenges in diagnosing and treating post-treatment Lyme disease syndrome (PTLDS) and chronic Lyme disease 2, 4.
• Antibody testing for B. burgdorferi is an insensitive measure after treatment, and no other FDA-approved tests currently exist, making it difficult to determine when to repeat testing 4.
• The provided studies suggest that further research is needed to develop more specific diagnostic tests and treatments for Lyme disease and PTLDS 2, 3, 4, 5.

Diagnostic Challenges

• The diagnosis of Lyme disease and PTLDS is complex and often relies on clinical manifestations and serology, which can be misinterpreted or have false positives if confirmatory laboratory testing is not performed 3.
• The studies highlight the need for improved diagnostic tests and treatments for Lyme disease and PTLDS, as well as further research on the effector mechanisms that lead to pathology in some individuals 2, 3, 4, 5.

Treatment and Persistence

• The provided studies discuss the treatment of Lyme disease with antibiotics, including doxycycline, amoxicillin, and azithromycin, and the potential for persistent symptoms despite treatment 3, 5, 6.
• The studies suggest that some patients may experience persistent arthritis or post-treatment Lyme disease syndrome, and that further research is needed to understand the causes of these phenomena and to develop more effective treatments 3, 4, 5.